Provider Demographics
NPI:1346570082
Name:EMERY BEHAVIORAL HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:EMERY BEHAVIORAL HEALTH SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT/DIRECTOR OF OPERATIO
Authorized Official - Prefix:MR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:EMERY
Authorized Official - Suffix:
Authorized Official - Credentials:MSED
Authorized Official - Phone:570-522-0304
Mailing Address - Street 1:32 WHISPER CREEK DR
Mailing Address - Street 2:SUITE 7
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-7770
Mailing Address - Country:US
Mailing Address - Phone:570-522-0304
Mailing Address - Fax:570-522-0475
Practice Address - Street 1:235 MARKET ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SUNBURY
Practice Address - State:PA
Practice Address - Zip Code:17801-3401
Practice Address - Country:US
Practice Address - Phone:570-286-0987
Practice Address - Fax:570-286-0989
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMERY BEHAVIORAL HEALTH SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-12-31
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015898103TC0700X
PASW013397L104100000X
PASW126648104100000X
PACW0153801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1019047770002Medicaid
PA1019581500001Medicaid
PA1015177000001Medicaid
PA1019060380002Medicaid